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Metastatic Disease of the Spine

Dr. White is Orthopaedic and Neurosurgical Spinal Surgery Fellow, Rothman Institute at Thomas Jefferson University, Philadelphia, PA. Dr. Kwon is Assistant Professor, Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada. Dr. Lindskog is Associate Professor, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT. Dr. Friedlaender is Professor and Chairman, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine. Dr. Grauer is Associate Professor, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. White, Dr. Kwon, Dr. Lindskog, Dr. Friedlaender, and Dr. Grauer.

Reprint requests: Dr. Grauer, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT 06520-8071.

Metastatic spine disease accounts for 10% to 30% of new cancer diagnoses annually. The most frequent presentation is axial pain. A thorough spinal examination includes assessment of local tenderness, deformity, limitation of motion, and signs of nerve root or cord compression. Plain radiographs are obtained routinely; for a suspected or known malignancy, radionuclide studies are essential. Magnetic resonance imaging is more specific than bone scans. Computed tomography–guided biopsy is considered to be safe and accurate for evaluating spinal lesions. Treatment is multidisciplinary, and virtually all treatment is palliative. Management is guided by three key issues: neurologic compromise, spinal instability, and individual patient factors. Site-directed radiation, with or without chemotherapy, is the mainstay of treating painful lesions that are not impinging on neural elements. New data documenting the benefit of surgical decompression using improved techniques such as anterior approaches have amplified the role of the spine surgeon in the care of these patients.